Mathew Leonardi

Mathew Leonardi
McMaster University | McMaster · Department of Obstetrics and Gynaecology

BSc, MD, PhD FRCSC

About

158
Publications
39,633
Reads
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743
Citations
Citations since 2016
148 Research Items
721 Citations
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Introduction
Mathew is a minimally invasive gynecologic surgeon and sonologist @ McMaster University in Canada. He has been awarded his PhD @ University of Sydney, focused on the utility of ultrasound in the diagnosis and surgical management of endometriosis. He is currently involved with a variety of local and multicentre international projects on endometriosis, ranging from studies on pathophysiology to assessment of surgical outcomes. Full supervisory privileges @ Mac MedSci Grad Program.
Additional affiliations
November 2018 - present
The University of Sydney
Position
  • Lecturer
November 2017 - present
Nepean Hospital
Position
  • Research Associate
Education
January 2018 - April 2022
The University of Sydney
Field of study
  • Medicine
June 2012 - June 2017
University of Toronto
Field of study
  • Obstetrics & Gynaecology
September 2008 - June 2012
University of Toronto
Field of study
  • Medicine

Publications

Publications (158)
Article
Full-text available
Ultrasound has become an invaluable tool for the workup and management of patients with symptoms and signs of endometriosis. Until the publication on the systematic approach to ultrasound in patients with suspected endometriosis by the International Deep Endometriosis Analysis (IDEA) group, there was significant heterogeneity in the scientific lite...
Article
Full-text available
Deep endometriosis (DE) of the uterosacral ligaments (USLs) has been reported to be the most common site of DE in the pelvis 1. A nodule within the USL may infiltrate the parametrium, increasing the complexity of surgical resection and larger nodules noted on transvaginal ultrasound (TVS) (≥17mm) should raise suspicion for ureteral involvement 2. N...
Article
Full-text available
Background: The aetiology and pathogenesis of endometriosis is still under investigation. There is evidence that there is a complex bidirectional interaction between endometriosis and the microbiome. Objective: To systematically review the available literature on the endometriosis-microbiome interaction, with the aim of guiding future inquiries...
Article
Full-text available
Endometriosis is a chronic systemic disease that can cause pain, infertility, and reduced quality of life in those affected. Diagnosing endometriosis remains challenging, which yields diagnostic delays for patients. Diagnostic test accuracy research in endometriosis can be difficult due to verification bias, as not all patients with endometriosis u...
Article
Full-text available
The care of patients with endometriosis has been complicated by the coronavirus disease 2019 (COVID-19) pandemic. Medical and allied healthcare appointments and surgeries are being temporarily postponed. Mandatory self-isolation has created new obstacles for individuals with endometriosis seeking pain relief and improvement in their quality of life...
Conference Paper
Study Objective Review the background, clinical presentation, and options for diagnosing superficial endometriosis: 1) Illustrate the steps to visualize SE with ultrasound and the relevant sonographic features and 2) and discuss the clinical importance of a non-operative diagnosis as well as the limitations of ultrasound in this context. Design Ed...
Conference Paper
Study Objective We aim to assess the performance of a modified AAGL (mAAGL) endometriosis classification system and its inter-observer reproducibility. Design Retrospective diagnostic accuracy & inter-observer reproducibility study. Setting 2 gynecology units in metropolitan Sydney, Australia. Patients or Participants Patients with suspected end...
Conference Paper
Study Objective We aim to assess the performance of the "2021 AAGL Endometriosis Classification" compared with revised American Society of Reproductive Medicine (rASRM), Ultrasound Based Endometriosis Staging System (UBESS) and modified Ultrasound Based Endometriosis Staging System (mUBESS) to predict AAGL levels of surgical complexity. Design Mul...
Conference Paper
Study Objective Key steps in management of atypical presentation of large uterine fibroids during pregnancy. Design McMaster University Medical Centre. Setting Case Review. Patients or Participants Single case. Interventions Expert Ultrasound evaluation. Measurements and Main Results Safe laparoscopic intervention guided by ultrasound for mana...
Conference Paper
Study Objective Incomplete surgery for endometriosis is associated with increased disease severity, however, there is limited data on potential reasons. This study aims to elucidate patient and surgical factors associated with previous incomplete and complete surgery. Design A retrospective cohort study of patients referred to a minimally invasive...
Conference Paper
Study Objective We aim to externally validate the “2021 AAGL Endometriosis Classification” system. Design A multicenter, retrospective, diagnostic accuracy study. Setting 2 gynecology units in metropolitan Sydney, Australia. Patients or Participants Patients with suspected endometriosis who underwent laparoscopy between January 2016 and October...
Conference Paper
Study Objective To develop a standardized, consensus-based international ultrasound approach for women with chronic pelvic pain (CPP) that can be applied in clinical practice. Design Delphi survey. Setting N/A. Patients or Participants International panel of experts in chronic pelvic pain and ultrasound, selected for their clinical and scientifi...
Conference Paper
Study Objective To describe the background, pathogenesis, and clinical symptomatology of endometrial osseous metaplasia (EOM). To outline the work-up and management of patients with suspected EOM. To highlight key considerations in managing patients with EOM. Design A Case Report. Setting Tertiary Care Academic Centre. Patients or Participants C...
Article
Full-text available
STUDY QUESTION How is endometriosis extent described by the #Enzian classification compared to the revised American Society for Reproductive Medicine (rASRM) stages in women undergoing radical surgery for deep endometriosis (DE)? SUMMARY ANSWER The prevalence and severity grade of endometriotic lesions and adhesions as well as the total number of...
Article
Does cigarette smoking impact the embryonic growth rate in the first trimester? This is a retrospective multicentre observational study of 2912 pregnancies. Women who presented to the early pregnancy and perinatal ultrasound units between 2010 and 2019 were included in the study. The data collected included the following: smoking status, the crown–...
Article
Study objectives To develop a model, including clinical features and ultrasound findings, to predict the need for ureterolysis (i.e. dissection of the ureter) during laparoscopy for endometriosis. Design A retrospective observational study of patients who had transvaginal ultrasound (TVS) according to the International Deep Endometriosis Analysis...
Article
Full-text available
The path to the characterization of endometriosis since its first discovery by Karl von Rokitansky 150 years ago has been a rocky one (von Rokitansky, 1860). Linking histology to clinical observations was perplexed by infamous theories, such as Sigmund Freud’s attributing endometriosis symptoms to ‘hysteria’, but eventually defined a milestone that...
Article
Full-text available
Lay summary Endometriosis is a benign disease that can cause pain and infertility in women. Debate exists over how endometriosis should best be diagnosed. On one hand, endometriosis can be diagnosed by directly examining pelvic anatomy via a surgical procedure known as diagnostic laparoscopy. On the other hand, the disease can be diagnosed via non-...
Article
Full-text available
Graphical abstract: Abstract: Endometriosis is a common yet under-recognised chronic disease with one in nine (more than 830,000) women and those assigned female at birth diagnosed with endometriosis by the age of 44 years in Australia. In 2018, Australia was the first country to develop a roadmap and blueprint to tackle endometriosis in a natio...
Article
Objectives: To evaluate the diagnostic accuracy of transvaginal ultrasound (TVS) to predict ovarian endometriomas (OE), overall deep endometriosis (DE), and DE locations by following the International Deep Endometriosis Analysis (IDEA) consensus statement. Methods: This was an international, multicenter prospective diagnostic accuracy study invo...
Preprint
Full-text available
Objective To externally validate the "2021 AAGL Endometriosis Classification" staging system. Design Retrospective, diagnostic accuracy study Setting Multicentre Population or Sample Two hundred and seventy-two endometriosis patients (January 2016-October 2021) Methods Three independent observers analysed coded surgical data to assign an AAGL surgi...
Preprint
Full-text available
Objectives: To determine the impact of the diagnostic test method (clinical, diagnostic imaging, or diagnostic laparoscopy) of endometriosis on the individual’s sense of control over their disease and their perceived access to social supports. Design: Retrospective cohort study. Setting: International. Population: 1,634 people aged 18-55 who had re...
Article
Full-text available
Uterine fibroids are common benign tumors that occur in up to 80% of women. Approximately half of the women affected experience considerable physical, psychological, and economic burdens and impact on quality of life due to symptoms such as heavy menstrual bleeding, pelvic pain, and infertility. Several medical and surgical options are available to...
Article
Introduction: Endometriosis affects 1 in 10 women worldwide, with most experiencing difficulties achieving adequate symptom control. These difficulties have been compounded by the onset of the COVID-19 pandemic due to worldwide shifts in health care resource allocation. As cannabis is a relatively common form of self-management in endometriosis, th...
Chapter
Diagnosing endometriosis has been a challenging and controversial concept for years. When considering a patient with pelvic pain, endometriosis may be suspected based on the clinical history and physical examination. While a presumptive clinical diagnosis can be provided, more accurate and tangible diagnostic tests may be sought by patients and cli...
Article
Background Chronic pelvic pain (CPP) is a common gynaecological condition accounting for 20% of all gynaecological referrals. There are wide ranges of causes with overlapping symptomatology, therefore the management of the condition is a formidable challenge for clinicians. The aetiology of CPP is heterogeneous and in many cases, no clear diagnosis...
Article
Objective: To compare the preoperative detection of endometriosis using transvaginal sonography (TVS) supplemented by transabdominal sonography (TAS) with surgical assessment of disease, using the #Enzian classification for endometriosis. Methods: This was a prospective multicenter diagnostic accuracy study of women undergoing TVS/TAS and radica...
Article
Full-text available
Objective: To assess the general population's knowledge regarding the utility and availability of tools to diagnosis endometriosis, with a focus on ultrasound. Design: An international cross-sectional online survey study was performed between August and October 2019. Setting and population: 5301 respondents, representing 73 countries. Methods...
Article
Full-text available
Defined by the extrauterine growth of estrogen-dependent endometrial-like epithelial and stromal cells, endometriosis is a common gynecological and systemic inflammatory disease affecting approximately 179 million people assigned female at birth (predominately cisgender women) worldwide. Although most frequently detected in the pelvic cavity, endom...
Article
Full-text available
Dear editor, We enthusiastically read the article entitled “AAGL 2021 Endometriosis Classification: An Anatomy-Based Surgical Complexity Score”1. We congratulate the authors on this immense endeavour and the resultant publication. Generally, classification systems intend to be simple quantitative tools to standardize nomenclature, ensure clear comm...
Chapter
One of modern healthcare's most controversial areas, reproductive medicine is an emerging discipline that fosters hugely divergent opinions on topics such as laboratory techniques, clinical management and ethical considerations. Highlighting over 50 contentious topics in reproductive medicine, this book presents expertly argued opinions are present...
Article
Background There are no current standardized and accepted methods to characterize the surgical complexity of a laparoscopic hysterectomy. This leads to challenges when trying to understand the relationship between patient and surgical features and surgical outcomes. The development of core feature sets for laparoscopic hysterectomy studies would en...
Article
Full-text available
STUDY QUESTION Is there an ideal imaging modality for the detection of uterosacral ligaments/torus uterinus (USL), rectovaginal septum (RVS) and vaginal deep endometriosis (DE) in women with a clinical history of endometriosis? SUMMARY ANSWER The sensitivity for the detection of USL, RVS and vaginal DE using MRI seems to be better than transvagina...
Conference Paper
Study Objective We aimed to review the effectiveness and safety of surgical interventions in the management of patients experiencing chronic pelvic pain syndrome (CPPS), which excluds those with pain known to be caused by i) endometriosis; ii) adenomyosis; iii) primary dysmenorrhoea; iv) active chronic pelvic inflammatory disease; v) irritable bowe...
Conference Paper
Study Objective Review of CS scar pregnancies. Design Video outlining clinical evaluation, diagnostic tools and surgical management of CS scar pregnancies. Setting Case review, McMaster University. Patients or Participants Case discussion and review. Interventions U/S diagnosis and laparoscopic intervention. Measurements and Main Results Ultra...
Conference Paper
Study Objective No objective, standardized language exists to characterize the complexity of a laparoscopic hysterectomy. This leads to challenges when trying to understand the relationship between patient and surgical features and post-operative outcomes. Predicting surgical complexity pre-operatively will also remain challenging if standardized c...
Conference Paper
Study Objective Investigate agreement of the three diameters of the rectosigmoid deep endometriosis (DE) lesion size between pre-surgical evaluation with transvaginal sonography (TVS) and post-surgical specimen measurements (PSM). Design A prospective observational study. TVS was performed pre-surgically to evaluate lesion size compared to PSM in...
Article
Objectives This study aimed to evaluate the impact of different periodontal treatment strategies during pregnancy on perinatal outcomes. Study selection This systematic review and meta-analysis of clinical trials was conducted according to PRISMA guidelines to assess the effect of mouthwash in addition to scaling and root planing (SRPM) on pregnan...
Article
Full-text available
The current approach to treating endometriosis is often inadequate or intolerable for many patients. Until more effective therapies are available, we should aim to maximize the effectiveness of our current options. Optimization may be possible by reducing nocebo effects, which are the negative therapeutic effects not directly caused by a treatment....
Article
Full-text available
Objectives: Pouch of Douglas (POD) obliteration is a severe consequence of inflammation in the pelvis, often seen in patients with endometriosis. The sliding sign is a dynamic transvaginal ultrasound (TVS) test that can diagnose POD obliteration. We aimed to develop a deep learning (DL) model to automatically classify the state of the POD using rec...
Article
Full-text available
Endometriosis is a common gynaecological condition characterized by estrogen dependence, chronic pelvic pain, infertility and diagnostic delay of between 5.4 and 12 years. Despite extensive study, no biomarker, either alone or in combination with other markers, has proven superior to laparoscopy for the diagnosis of endometriosis. Recent studies re...
Article
Full-text available
Extrapelvic endometriosis, although rare, can present in the musculoskeletal system of reproductive-age women and cause significant pain and morbidity. The pathophysiology of this disease is not well understood. In this study, we described the case of a 39-year-old women with an inner-thigh mass causing catamenial pain. Core-biopsy of the mass conf...
Article
Full-text available
In this case, we demonstrate that awareness of decidualized endometriomas combined with understanding pre-pregnancy history and the sonographic features of decidualized endometriomas aided in resolving the diagnostic dilemma of an ovarian mass in pregnancy. Consequently, we prevented an unnecessary oophorectomy and reduced the anxiety that arose se...
Article
Full-text available
lncRNA, miRNA, and proteins in exosomes isolated from the serum and peritoneal fluid of women with endometriosis are differentially expressed compared to controls. Experimental evidence demonstrates that exosome content modulates migration, invasion, angiogenesis and inflammation, central processes in endometriosis. We suggest that exosomes and the...
Article
Objective To review the diagnostic accuracy and determine the optimum imaging modality for the detection of bladder deep endometriosis (DE) in women with a clinical suspicion of endometriosis. Methods A systematic review of studies published from inception to May 2020 using Embase, Google Scholar, Medline, PubMed and Scopus. Prospective studies, w...
Article
Full-text available
Objectives: To investigate the agreement of the three diameters of the rectosigmoid deep endometriosis (DE) between pre-surgical evaluation with transvaginal sonography (TVS) and post-surgical specimen measurements (PSM). Methods: A prospective observational multi-center study including symptomatic women undergoing surgical treatment for DE of t...
Preprint
Full-text available
Objective: To assess the general population’s knowledge regarding the utility and availability of tools to diagnosis endometriosis, with focus on ultrasound. Design: An international cross-sectional online survey study was performed between August and October 2019. Setting and Population: 5301 respondents, representing 73 countries. Methods: 23 que...
Article
To the Editor: In a recent publication in this journal, Balcacer et al,1 proposed the “speckle sign” as a marker of deep endometriosis (DE) that could be added as a supplementary tool to current standard of care transvaginal ultrasound (TVUS) protocols used in radiology departments. Integrating assessment of DE into the standard of care pelvic ultr...
Preprint
Full-text available
At first glance, endometriosis appears to be a relatively simple disease, characterised by endometrial-like glands and stroma where they are not supposed to be. In practice, however, endometriosis is far from a simple disease. Non-specific symptoms often accompany the classical clinical phenotype of dysmenorrhea, dyspareunia, and dyschezia, leading...
Article
We aim to first systematically review and perform a meta‐analysis of the diagnostic accuracy of transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI) and, second, to evaluate the accuracy of various sonographic diagnostic criteria for adenomyosis. A search of PubMed and Embase yielded 32 eligible studies. In diagnosing adenomyosis, th...
Article
Increasing diagnostic accuracy of endometriosis by creating a feedback loop amongst sonologists, pelvic surgeons and histopathologists.
Article
To the Editor: We read with great attention the article published by Martire et al.1 We congratulate the authors on investigating an important scientific area: the appearance of the pelvis on ultrasound imaging after surgery for endometriosis. The authors report that this is “the first study to describe the transvaginal ultrasound features of patie...
Article
Full-text available
Misra and colleagues have performed a randomised controlled trial (RCT) comparing two surgical tools in the treatment of endometriosis (hook electrodiathermy versus helium thermal coagulator (HTC)) (Misra et al. BJOG 2020; xxxx). The primary outcome evaluated was cyclical pain 12‐weeks post‐operatively, assessed on a visual analogue scale (VAS) (0‐...
Article
Full-text available
Study question: Is expectant management (EM) of tubal ectopic pregnancy (EP) an effective and safe treatment strategy when compared to alternative interventions? Summary answer: There is insufficient evidence to conclude EM yields a difference in the resolution of tubal EP, the avoidance of surgery or time to resolution of tubal EP when compared...
Conference Paper
Full-text available
Objectives Considered an advanced surgical skill, ureterolysis is necessary to ensure safe surgical treatment of endometriosis. The objective of this study was to develop a decision tree model to predict the need for ureterolysis during laparoscopy for endometriosis. Methods We undertook a retrospective observational study of 94 women who had an a...
Conference Paper
Full-text available
Objectives Rectouterine pouch obliteration (RPO) is a severe consequence of inflammation in the pelvis, often seen in patients with endometriosis. The sliding sign is a dynamic transvaginal ultrasound (TVS) test that can diagnose RPO. We aimed to develop a machine learning (ML) network to automatically classify the state of the RP using recorded vi...
Conference Paper
Full-text available
Objectives To evaluate the diagnostic accuracy of transvaginal ultrasound (TVS) to predict overall deep endometriosis (DE) and DE locations by applying the IDEA terminology. Methods This was an international, multicentre prospective diagnostic accuracy study involving 9 centres across 6 countries (Aug 2018‐Nov 2019). Consecutive participants were...
Conference Paper
Full-text available
Objectives We aimed to assess the knowledge of the lay general population regarding the utility and availability of tools to diagnosis endometriosis, with special attention on ultrasound. Methods An international cross‐sectional e‐mail survey study was performed between August and October 2019. Questions were designed by the study team and piloted...
Article
Abstract Objective: To review the diagnostic accuracy and determine the optimum imaging modality for the detection of rectosigmoid deep endometriosis (DE) in women with a clinical history of endometriosis. Methods: A systematic review was conducted using PubMed, Medline, Scopus, Embase and Google Scholar to identify studies published between Janua...
Article
Full-text available
We aim to describe the diagnosis and surgical management of urinary tract endometriosis (UTE). We detail current diagnostic tools, including advanced transvaginal ultrasound, magnetic resonance imaging, and surgical diagnostic tools such as cystourethroscopy. While discussing surgical treatment options, we emphasize the importance of an interdiscip...
Preprint
We aim to describe the diagnosis and surgical management of urinary tract endometriosis (UTE). We detail current diagnostic tools including advanced transvaginal ultrasound, magnetic resonance imaging, and surgical diagnostic tools such as cystourethroscopy. While discussing surgical treatment options, we emphasize the importance of an interdiscipl...
Article
Objective To perform a pilot diagnostic accuracy study of a novel transvaginal ultrasonography procedure called saline-infusion sonoPODography to predict superficial endometriosis in patients with suspected endometriosis. Study design A prospective single-center diagnostic accuracy study was performed from September 2019-November 2019. The index t...
Article
Gynecologic surgery often requires visualization of the ureter and occasionally requires a ureterolysis, neither of which are standardized skills required for graduating obstetrician/gynaecologists as per educational standards. Most obstetrician/gynecologists do not complete minimally invasive gynecologic surgery fellowships, which endorse ureterol...